Medically induced preterm birth and the associations between prenatal care and infant mortality

Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Adverse effects of preterm birth have a direct correlation with the degree of prematurity, in which infants who are born extremely preterm (24–28 weeks gestation) have the worst outcomes. We sought to determine prominent risk factors for extreme PTB and whether these factors varied between various sub-populations with known risk factors such as previous PTB and multiple gestations. A population-based retrospective cohort study was conducted. Risk factors were examined in cases of extreme PTB in the general population, as well as various sub-groups: singleton and multiple gestations, women with a previous PTB, and women with indicated or induced PTB. A total of 334,415 deliveries were included, of which 1155 (0.35%) were in the extreme PTB group. Placenta previa (OR = 5.8, 95%CI 4.14–8.34, p < 0.001), multiple gestations (OR = 7.7, 95% CI 6.58–9.04, p < 0.001), and placental abruption (OR = 20.6, 95%CI 17.00–24.96, p < 0.001) were the strongest risk factors for extreme PTB. In sub-populations (multiple gestations, women with previous PTB and indicated PTBs), risk factors included placental abruption and previa, lack of prenatal care, and recurrent pregnancy loss. Singleton extreme PTB risk factors included nulliparity, lack of prenatal care, and placental abruption. Placental abruption was the strongest risk factor for extreme preterm birth in all groups, and risk factors did not differ significantly between sub-populations.

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The impact of changes in preterm birth among twins on stillbirth and infant mortality in the United States

Journal of Perinatology ◽

10.1038/jp.2014.119 ◽

2014 ◽

Vol 34 (11) ◽

pp. 823-829 ◽

Cited By ~ 7

Author(s):

D Getahun ◽

K Demissie ◽

S W Marcella ◽

G G Rhoads

Keyword(s):

United States ◽

Preterm Birth ◽

Infant Mortality ◽

The United States ◽

The Impact

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The expression of vulnerability through infant mortality in the municipality of Embu

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000500004 ◽

2008 ◽

Vol 126 (5) ◽

pp. 262-268 ◽

Cited By ~ 2

Author(s):

Renato Nabas Ventura ◽

Rosana Fiorini Puccini ◽

Nilza Nunes da Silva ◽

Edina Mariko Koga da Silva ◽

Eleonora Menicucci de Oliveira

Keyword(s):

Infant Mortality ◽

Prenatal Care ◽

Care Delivery ◽

Healthcare Access ◽

Secondary Data ◽

Healthcare Services ◽

Primary Data ◽

Access To Health Services ◽

One Year

CONTEXT AND OBJECTIVE: Infant mortality expresses a set of living, working and healthcare access conditions and opens up possibilities for adopting interventions to expand equity in healthcare. This study aimed to investigate vulnerability and the consequent differences in access to health services and occurrences of deaths among infants under one year of age in the municipality of Embu. DESIGN AND SETTING: This was a descriptive study in the municipality of Embu. METHODS: Primary data were collected through interviews with the families of children living in the municipality of Embu who died in the years 1996 and 1997 before reaching one year of age. Secondary data were obtained from death certificates. The variables collected related to living conditions, income, occupation, prenatal care, delivery and the healthcare provided for children. These data were compared with the results obtained from a study carried out in 1996. RESULTS: Statistically significant differences were found with regard to income, working without a formal employment contract and access to private health plans among the families of the children who died. There were also differences in access to and quality of prenatal care, frequency of low birth weight and neonatal intercurrences. CONCLUSIONS: The employment/unemployment situation was decisive in determining the degree of family stability and vulnerability to the occurrence of infant deaths, in addition to the conditions of access to and quality of healthcare services.

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Changes in fetal and infant mortality due to increases in preterm birth among twins

Paediatric and Perinatal Epidemiology ◽

10.1046/j.1365-3016.2001.00381-52.x ◽

2001 ◽

Vol 15 (4) ◽

pp. A17-A17 ◽

Cited By ~ 1

Author(s):

Ks Joseph ◽

S Marcoux ◽

A Ohlsson ◽

S Liu ◽

Ac Allen ◽

...

Keyword(s):

Preterm Birth ◽

Infant Mortality

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Joint contribution of socioeconomic circumstances and ethnic group to variations in preterm birth, neonatal mortality and infant mortality in England and Wales: a population-based retrospective cohort study using routine data from 2006 to 2012

BMJ Open ◽

10.1136/bmjopen-2018-028227 ◽

2019 ◽

Vol 9 (7) ◽

pp. e028227 ◽

Cited By ~ 2

Author(s):

Charles Opondo ◽

Ron Gray ◽

Jennifer Hollowell ◽

Yangmei Li ◽

Jennifer J Kurinczuk ◽

...

Keyword(s):

Preterm Birth ◽

Infant Mortality ◽

Ethnic Group ◽

Ethnic Groups ◽

Neonatal Mortality ◽

Birth Outcomes ◽

Secondary Outcome ◽

Adverse Birth Outcomes ◽

England And Wales ◽

Deprived Areas

ObjectivesThis study aimed to describe the variation in risks of adverse birth outcomes across ethnic groups and socioeconomic circumstances, and to explore the evidence of mediation by socioeconomic circumstances of the effect of ethnicity on birth outcomes.SettingEngland and Wales.ParticipantsThe data came from the 4.6 million singleton live births between 2006 and 2012.ExposureThe main exposure was ethnic group. Socioeconomic circumstances, the hypothesised mediator, were measured using the Index of Multiple Deprivation (IMD), an area-level measure of deprivation, based on the mother’s place of residence.Primary and secondary outcome measuresThe primary outcomes were birth outcomes, namely: neonatal death, infant death and preterm birth. We estimated the slope and relative indices of inequality to describe differences in birth outcomes across IMD, and the proportion of the variance in birth outcomes across ethnic groups attributable to IMD. We investigated mediation by IMD on birth outcomes across ethnic groups using structural equation modelling.ResultsNeonatal mortality, infant mortality and preterm birth risks were 2.1 per 1000, 3.2 per 1000 and 5.6%, respectively. Babies in the most deprived areas had 47%–129% greater risk of adverse birth outcomes than those in the least deprived areas. Minority ethnic babies had 48%–138% greater risk of adverse birth outcomes compared with white British babies. Up to a third of the variance in birth outcomes across ethnic groups was attributable to differences in IMD, and there was strong statistical evidence of an indirect effect through IMD in the effect of ethnicity on birth outcomes.ConclusionThere is evidence that socioeconomic circumstances could be contributing to the differences in birth outcomes across ethnic groups.

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Infant Mortality among Adolescent Mothers in the United States: A 5-Year Analysis of Racial and Ethnic Disparities

American Journal of Perinatology ◽

10.1055/s-0040-1714678 ◽

2020 ◽

Author(s):

Matthew D. Moore ◽

Anne E. Brisendine ◽

Martha S. Wingate

Keyword(s):

United States ◽

Preterm Birth ◽

Infant Mortality ◽

Ethnic Disparities ◽

The United States ◽

Racial And Ethnic Disparities ◽

Postneonatal Mortality ◽

Maternal Characteristics ◽

Race Ethnicity ◽

Racial Ethnic

Objective This study was aimed to examine differences in infant mortality outcomes across maternal age subgroups less than 20 years in the United States with a specific focus on racial and ethnic disparities. Study Design Using National Center for Health Statistics cohort-linked live birth–infant death files (2009-2013) in this cross-sectional study, we calculated descriptive statistics by age (<15, 15–17, and 18–19 years) and racial/ethnic subgroups (non-Hispanic white [NHW], non-Hispanic black [NHB], and Hispanic) for infant, neonatal, and postneonatal mortality. Adjusted odds ratios (aOR) were calculated by race/ethnicity and age. Preterm birth and other maternal characteristics were included as covariates. Results Disparities were greatest for mothers <15 and NHB mothers. The risk of infant mortality among mothers <15 years compared to 18 to 19 years was higher regardless of race/ethnicity (NHW: aOR = 1.40, 95% confidence interval [CI]: 1.06–1.85; NHB: aOR = 1.28, 95% CI: 1.04–1.56; Hispanic: aOR = 1.36, 95%CI: 1.07–1.74). Compared to NHW mothers, NHB mothers had a consistently higher risk of infant mortality (15–17 years: aOR = 1.12, 95% CI: 1.03–1.21; 18–19 years: aOR = 1.21, 95% CI: 1.15–1.27), while Hispanic mothers had a consistently lower risk (15–17 years: aOR = 0.72, 95% CI: 0.66–0.78; 18–19 years: aOR = 0.74, 95% CI: 0.70–0.78). Adjusting for preterm birth had a greater influence than maternal characteristics on observed group differences in mortality. For neonatal and postneonatal mortality, patterns of disparities based on age and race/ethnicity differed from those of overall infant mortality. Conclusion Although infants born to younger mothers were at increased risk of mortality, variations by race/ethnicity and timing of death existed. When adjusted for preterm birth, differences in risk across age subgroups declined and, for some racial/ethnic groups, disappeared. Key Points

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Geovisualization and Spatial Analysis of Infant Mortality and Preterm Birth in Ohio, 2008-2015: Opportunities to Enhance Spatial Thinking

Public Health Reports ◽

10.1177/0033354920927854 ◽

2020 ◽

Vol 135 (4) ◽

pp. 472-482

Author(s):

Elisabeth Dowling Root ◽

Emelie D. Bailey ◽

Tyler Gorham ◽

Christopher Browning ◽

Chi Song ◽

...

Keyword(s):

Public Health ◽

Preterm Birth ◽

Spatial Analysis ◽

Infant Mortality ◽

Spatial Patterns ◽

Urban Areas ◽

Vital Statistics ◽

Infant Mortality Rate ◽

Spatial Inequalities ◽

Geographic Clustering

Objectives Geovisualization and spatial analysis are valuable tools for exploring and evaluating the complex social, economic, and environmental interactions that lead to spatial inequalities in health. The objective of this study was to describe spatial patterns of infant mortality and preterm birth in Ohio by using interactive mapping and spatial analysis. Methods We conducted a retrospective cohort study using Ohio vital statistics records from 2008-2015. We geocoded live births and infant deaths by using residential address at birth. We used multivariable logistic regression to adjust spatial and space–time cluster analyses that examined the geographic clustering of infant mortality and preterm birth and changes in spatial distribution over time. Results The overall infant mortality rate in Ohio during the study period was 6.55 per 1000 births; of 1 097 507 births, 10.3% (n = 112 552) were preterm. We found significant geographic clustering of both infant mortality and preterm birth centered on large urban areas. However, when known demographic risk factors were taken into account, urban clusters disappeared and, for preterm birth, new rural clusters appeared. Conclusions Although many public health agencies have the capacity to create maps of health outcomes, complex spatial analysis and geovisualization techniques are still challenging for public health practitioners to use and understand. We found that actively engaging policymakers in reviewing results of the cluster analysis improved understanding of the processes driving spatial patterns of birth outcomes in the state.

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